Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan

Chen Wen Fang, Yi Te Tsai, Ping Chen Chou, Hsi Ming Chen, Chien Ming Lu, Chen Rong Tsao, Chih Lin Chen, Mu Chien Sun, Yu Song Shih, Cheng Yang Hsieh, Lu An Chen, Po Lin Chen, Jung Tze Yeh, Yi Heng Li

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Abstract

Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. Results: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA 2 DS 2 -VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose.78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P =.016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. Conclusion: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.

Original languageEnglish
Pages (from-to)815-820
Number of pages6
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number3
DOIs
Publication statusPublished - 2019 Mar

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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    Fang, C. W., Tsai, Y. T., Chou, P. C., Chen, H. M., Lu, C. M., Tsao, C. R., Chen, C. L., Sun, M. C., Shih, Y. S., Hsieh, C. Y., Chen, L. A., Chen, P. L., Yeh, J. T., & Li, Y. H. (2019). Intravenous Thrombolysis in Acute Ischemic Stroke After Idarucizumab Reversal of Dabigatran Effect: Analysis of the Cases From Taiwan. Journal of Stroke and Cerebrovascular Diseases, 28(3), 815-820. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.029